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Type: Journal article
Title: VV' alternans triplets on near-field ICD intracardiac electrogram is associated with mortality
Author: Baumert, M.
Kabir, M.
Dalouk, K.
Henrikson, C.
Tereshchenko, L.
Citation: PACE - Pacing and Clinical Electrophysiology, 2015; 38(5):547-557
Publisher: Wiley
Issue Date: 2015
ISSN: 0147-8389
Statement of
M. Baumert, M.M. Kabir, K. Dalouk, C.A. Henrikson, L.G. Tereshchenko
Abstract: Background In heart failure patients with implantable cardioverter defibrillator (ICD) the risk of death from causes other than tachyarrhythmia is substantial. Benefit from ICD is determined by two competing risks: appropriate ICD shock or nonarrhythmic death. The goal of the study was to test predictors of competing outcomes. Methods Patients with structural heart disease (N = 234, mean age 58.5 ± 15.1; 71% men, 80% whites, 61% ischemic cardiomyopathy) and primary (75%) or secondary prevention ICD underwent a 5-minute baseline near-field electrogram (NF EGM) recording. VV′ alternans triplets were quantified as a percentage of three sinus VV′ cycles sequences of “short-long-short” or “long-short-long” order. Appropriate ICD shock for fast ventricular tachycardia (FVT, cycle length ≤240 ms)/ventricular fibrillation (VF) and composite nonarrhythmic death (pump failure death or heart transplant) served as competing outcomes. Results Over a median follow-up of 2.4 years, 26 patients (4.6% per person-year of follow-up) developed FVT/VF with ICD shock, and 35 (6.3% per person-year of follow-up) had nonarrhythmic death. In competing risk analysis, after adjustment for demographics, left ventricular ejection fraction, New York Heart Association class, cardiomyopathy type, use of class I antiarrhythmics, and diabetes, increased percentage of VV′ alternans triplets (>69%) was associated with nonarrhythmic death (subhazard ratio [SHR] 2.09; 95% confidence interval [CI] 1.03–4.23; P = 0.041), rather than with FVT/VF (SHR 1.05; 95% CI 0.45–2.46; P = 0.901). Risk of nonarrhythmic death was especially high in diabetics with VV′ alternans triplets in the highest quartile (SHR 3.46; 95% CI 1.41–8.50; P = 0.007). Conclusion In ICD patients with structural heart disease sinus VV′ alternans triplets on NF EGM is independently associated with nonarrhythmic death, rather than with FVT/VF.
Keywords: implantable cardioverter defibrillator; ventricular arrhythmia; mortality; competing risk
Rights: ©2015 Wiley Periodicals, Inc
RMID: 0030024561
DOI: 10.1111/pace.12594
Published version:;jsessionid=2D01EA3DD08F311D0A102862FA1E8F82.f02t02
Appears in Collections:Electrical and Electronic Engineering publications

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